Provider Demographics
NPI:1992896724
Name:MOORE, THOMAS LEE JR (RPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LEE
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:8326 BLOWING ROCK ROAD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-2112
Mailing Address - Country:US
Mailing Address - Phone:703-780-3942
Mailing Address - Fax:
Practice Address - Street 1:3750 OLD LEE HIGHWAY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22309-1870
Practice Address - Country:US
Practice Address - Phone:703-246-7113
Practice Address - Fax:703-246-5304
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist